UNAIR NEWS – Face is the identity of an individual. That is what made dr. Indri Lakshmi Putri, Sp.BP-RE (KKF) become a craniofacial plastic surgery expert. The profession is deemed to be rare in Indonesia as there are only dozens of experts.

In her busy schedule in Universitas Airlangga Hospital, she spared some of her time for interview. She was wearing the white jacket and she shared about her interest on craniofacial, operation experience and some of her story outside her profession.

“Face is an identity of a person. If you meet a person, one this you remember is the face. It is unavoidable that people will see physical appearance at first and it is represented by the face. Indirectly, a face determines for someone to be accepted or not in a group,” said the woman known as dr. Putri.

Craniofacial is one of plastic surgery studies which shapes and improves function and appearance of somebody from the facial bone, skull and soft tissue. For example, if there is organ abnormalities with the ears or face, it is the craniofacial expert’s job to reconstruct the face and the head until its shape and function are normal.

“We concern with final appearance so it can give happiness which can be valued psychologically. As usually unhappy people come to us,” said the doctor.

She admitted that her field of study is not very popular among other facial surgery specialists.

“If there is a seminar on craniofacial, there is a room for esthetic study, hand and surgery and craniofacial. Usually there are only 10-20% of doctors who participate. It shows that many doctors are not interested in craniofacial because the operation is complicated. In the esthetics, we can shape the nose in two hours compared to shape the ear which spends 6-8 hours of operation,” said Doctor Putri.

Facing Challenges
Reconstructing face and skull is itself a challenge for the graduate of Faculty of Medicine (FK) UNAIR. It demands accuracy and carefulness so the patient will be pleased with the new face created by the doctor.

Just like in the case of two siblings on Thursday, March 17. Doctor Putri and her team succeeded in operating two patients of crouzon syndrome through mid-facial bone advancement technique. The technique was the first ever done in Indonesia.

“The problem was forehead and midfacial bones’ growth is impeded. Their faces were like old women. The first phase was to deal with the forehead bone. We moved it forward because if it can’t grow, the brain will be pressed. If the brain pressed, it can’t grow too, Their eyes will stick out too,” said the 33 year old doctor.

In the operation in collaboration with a team from Erasmus Medical Center, Holland, she arrange the bones so that they will look normal. The challenge is to shape bone which is pathological. The bone tends to be thin and asymmetrical.

After the frontal bone shaped, the team continued with the bottom facial bone to improve the breathing.

“If obstructed, there will be many problems. Operation ended with the esthetic phase. We shaped the face so that they can be accepted in the community,” said the doctor who is keen on basketball.

Besides facial bone advancement, she has performed an operation for patient without ears (microtia). The treatment has two phases with high risks. The worst risk is hemorrhage and death. Therefore, it has to be performed carefully as it involves skin graft.

The doctor has to make a new ear with material from the patient’s body. To make an ear, the doctor has to adjust the normal ear pattern of the patients.

“We make the pattern. It is then cut and sterilized. We make the ear by using 4 ribs and finally shaped it into an ear. So, there is a sculpting and smoothing. Just like a sculpture,” said doctor Putri.

Dissatisfaction on the previous operation made her to update her knowledge. The mother of two said that for six months in 2015, she studied craniofacial reconstruction in three countries. They were Craniofacial Center Erasmus Medical Center in Holland, Chang Gung Craniofacial Center in Taiwan, and Nagata Microtia and Reconstructive Plastic Surgery Clinic in Japan.

Her studies bring results. In a microtia case, while showing her works of making ears, doctor Putri felt that there was improvement on her works.

“They said, Doc, it seemed that one operation is enough. But we said that they should not feel glad only with an attached ear. But they were happy and finally they blend in with friends. They felt enthusiasm with a new ear. They said that they wanted to show their new ear to their friend and teachers. Things like that are invaluable, in my opinion. That is patients’ satisfaction as they do not feel shy anymore,” said the doctor who will take her doctoral study in FK UNAIR next September 2016.

Another challenge was the lack of information in the society, even in the medical staff itself. Doctor Putri always encourages them to look for reliable source of information. Because abnormalities often noticed during pregnancy but it is not referred to reliable hospital.

“Don’t take easy with abnormal face patients. Consult to a plastic surgeon, as we (craniofacial) are only found in big cities. And find the information in the internet. We hope that there are no more patients with late condition. They who have ear abnormalities came to us after they were 16. What happened? The cartilages difficult to bend and hardened. To shape it will be more difficult compared to performing operation at the age of nine or ten,” said the doctor who has performed in Java Jazz Festival.

Craniofacial operation is available in UNAIR Hospital. With competent medical staff and service, the craniofacial operation is also covered by healthcare insurance (BPJS Kesehatan).
“Coordination is easy because either in Soetomo (RSUD Dr. Soetomo) and RS UNAIR, the department was under UNAIR. If in Soetomo, the patients were many. There’s a long queue. With UNAIR Hospital, some patients can be operated even faster,” she said.

She hoped that RSUD Dr. Soetomo and RS UNAIR can be the most referred hospitals in eastern Indonesia, even at national level for craniofacial cases.(*)

Author: Defrina Sukma S.
Editor : Binti Q. Masruroh